Texas Department of Aging and Disability Services
Resources for DADS service providers

LON documentation — Medical increase (ICF/ID only)

The following indicates the essential documentation to be submitted to the Texas Department of Aging and Disability Services (DADS), Access and Intake, IDD Waivers Program Enrollment/Utilization Review (PE/UR)  to support the Inventory for Client and Agency Planning (ICAP) ratings and increased services and supports being provided to an individual in the Intermediate Care Facilities for Persons with an Intellectual Disability (ICF/ID) program that would warrant an increased Level of Need (LON) due to medical issues/problems and the need for nursing interventions totaling more than 180 minutes weekly.

Initial Request

  1. Form 8603, Level of Need (LON) Review/Increase Cover Sheet.
  2. A cover letter describing the individual's medical/nursing issues and needed nursing interventions (optional).
  3. A complete copy of the current ICAP response booklet and (computer) scoring sheet.
  4. The latest annual staffing and individual program plan (IPP).
  5. Any pertinent and current (within the past year):
    • Team/interim meetings relating to medical and behavioral problems/issues.
    • Any professional assessments that discuss the changes in the individual's medical condition or changes in needed medical and behavioral interventions.
    • Staff/progress notes supporting the Adaptive and Problem Behavior ratings on the ICAP.
    • Other documents that would show the nursing services needed and validate the LON increase such as:
      1. Nursing narrative notes
      2. Nursing assessments
      3. Physician assessments
      4. Physician orders
      5. Current medication sheets
      6. Current treatment sheets
  6. A completed Form 8658, Medical Increase Worksheet — ICF/MR Only (Nursing Services Provided > 180 Minutes per Week, indicating:
    • The ongoing/chronic medical condition(s) which require direct nursing services greater than 180 minutes weekly.
    • The treatments and other direct nursing service requirements for this individual.
    • How the amount of time required to complete the nursing task was determined.
    • If applicable, address the frequency, time required (duration) and extenuating factors relating to services that may appear to require excessive nursing involvement.

Per Information Letter No. 11-74 (PDF format), as of June 20, 2011, DADS will not require program providers to submit a packet of documentation to accompany a request to renew a previously authorized initial LON increase. The provider will still be required to submit the request to renew a LON increase through the electronic submission of the Intellectual Disability/Related Condition (ID/RC) Assessment. The provider will also continue to be required to maintain the complete documentation and justification for the LON increase in the individual's record. These records are subject to review during any on-site review conducted by PE/UR staff or if requested by DADS.

Documentation should be mailed to:

Mailing Address:
Texas Department of Aging and Disability Services
Access & Intake
IDD Waivers Program Enrollment/Utilization Review
Mail Code: W355
P.O. Box 149030
Austin, TX 78714-9030

Physical Address:
Texas Department of Aging and Disability Services
Access & Intake
IDD Waivers Program Enrollment/Utilization Review
MC: W355
701 W. 51st St.
Austin, TX 78751

Fax: 512-438-4249
(Note: Do not fax more than 20 pages without prior approval.)

If you have questions, please call 512-438-5055 and indicate that you have a LON question.

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Updated: September 5, 2012